Double-blind, randomized study of venlafaxine, clomipramine and trazodone in geriatric patients with major depression

This was a six-week, multicentre, randomized, double-blind trial of the efficacy and tolerability of venlafaxine, trazodone and clomipramine in geriatric patients. Outpatients, inpatients or day hospital patients aged ≥ 65 years and satisfying DSM-IIIR criteria for major depression with symptoms of depression for at least 1 month, with a Mini-Mental State Examination score of at least 23 and a MADRS score of at least 24 were eligible. Treatment was started with venlafaxine 37.5 mg, clomipramine 25 mg or trazodone 50 mg and increased to venlafaxine 37.5 mg b.i.d., clomipramine 25 mg b.i.d. or trazodone 50 mg t.i.d. on day 2. On study day 14 or 21, the dose could be increased to venlafaxine 75 mg b.i.d., clomipramine 50 mg b.i.d. or trazodone 100 mg t.i.d. One hundred and seventy patients (58 clomipramine, 57 trazodone, 55 venlafaxine) were evaluable. Decreases in the HAM-D and MADRS were significantly (P ≤ 0.05) greater with venlafaxine and clomipramine compared with trazodone. At the end of treatment, 74% of venlafaxine patients, 69% of clomipramine patients and 57% of trazodone patients had a CGI score of very much improved or much improved (P ≤ 0.05). Significantly fewer (P ≤ 0.02) patients treated with venlafaxine (20%) reported at least one adverse event compared with clomipramine (28%) and trazodone (37%). The results from this study show venlafaxine to have similar efficacy to clomipramine and superior tolerability to clomipramine and trazodone when treating major depression in geriatric patients.